"Dr. Lynne Fenton testified before a packed courtroom that Holmes told her in March 2012 that he had “homicidal thoughts” – as often as three or four times a day. As his treatment progressed, he told her his obsession with killing was only getting worse.
And yet, Fenton told a jury there was little she could do because Holmes never talked about specifics. She couldn’t place him under a psychiatric hold because he never disclosed his intention to kill – even while he was acquiring weapons and “casing” a movie theater. And he never named a target, she testified.
…
During one session, she said, Holmes described homicide as “a solution to the biological problem,” but added “you can’t kill everyone, so it’s not an effective solution.
…
Fenton testified that she asked Holmes if he intended to act on his homicidal impulses, and he said he did not plan to take action.”
Well, okay then. As long as the psychotic, paranoid and highly anxious (according to her) patient says he doesn’t plan to act on his frequently expressed homicidal impulses, no reason not to believe him.
The doctor knows she might be liable because she possibly breached her duty to warn…
This is apparently this is the big deal - to be reportable, it has to be a credible threat against an identifiable person or people (remember the Tarasoff case?), and there has to be a (common law or statutory) duty to warn/duty to protect.
I’m more curious as to what a psychiatrist can testify to in open court legally after the arrest or death of a patient. For instance, I didn’t realize that the psychiatrist testifying here (without the consent of the defense) was legal. What’s the law regarding this?
If people were regularly reported for expressing homicidal thoughts … people who want treatment would be afraid to see a therapist because such a large number of people would be reported and lives ruined. And if you went, you wouldn’t be honest because your life would be ruined by expressing sentiments that any commuter, any one who works pretty much anywhere, etc. can and probably should rationally have. One might say, “well, the thoughts have to be serious”, but who can say what is and what isn’t unless and until there are some actual signs of action. This is why, for example, you can’t charge a person with conspiracy to commit a crime unless there’s been an overt action not merely discussion.
I’ve taught masters’ level counseling/therapy ethics, and one of my main research interests is suicide (which often gets lumped in with homicidality–“danger to self or others”–though I think that doing so often does more harm than good). It’s important to note in this case that the psychiatrist did indeed report Holmes to CU’s behavior intervention team, which almost always includes law enforcement and legal personnel. BITs come out of the Virginia Tech tragedy and are designed to provide a more comprehensive, united university response to students who display concerning behavior; often, these are de facto for homcidality or suicidality only but some may work with students who display, for example, symptoms of eating disorders, like severe weight loss or purging. I read something in the media that said the CU BIT dropped Holmes’ case once he withrew from the university, as university BITs deal only with students (and sometimes faculty or staff). Anyway, the point is that a) she did report it to the broader university and b) reporting non-specified thoughts of homicide with no admitted plan, means. or intent to act to outside law enforcement probably wouldn’t have met the legal standards of “imminent harm” or “credible threat,” and at most, would have triggered a welfare check from the police, if that.
As for at what point health professionals can and should be able to break confidentiality and how law enforcement should respond, that’s a messy issue with no good answer. We, as a field, aren’t good at predicting violence/homicide (suicide is somewhat easier to predict, in large part because people are more open about it and more ambivalent about it), and murder, especially mass murder, is a rare event. Coupled with this is the fact that hindsight is 20/20 and that sensitivity and specificity come into play. For example, Adam Lanza was a socially awkward loner who committed mass homicide, but for every Adam Lanza, there are a ton of people with same profile who never commit any violence. So, do we lock up or restrict the rights of 100,000 people in hopes of “catching” the one who might be violent, even if we’re locking up 99,999 innocent, non-violent people because they happen to share a similar profile? The issue @Lergnom brought up is also a consideration, and it came up, big time, about 5-10 years among with regards to suicide and suicidal ideation among college students. Universities were responding to students reporting suicidal ideation or suicide attempts by suspending them or kicking them out of the dorms. The lesson here was basically “don’t seek treatment for suicidality if you want to keep going to school here,” which is not the best culture to promote. In the end, the OCR ruled that you couldn’t simply give someone a conduct violation or suspension because of suicidal thoughts or behaviors unless it was significantly disruptive and the university very clearly took other steps to ameliorate the situation first (note that this only applies to suicidality, not homicidality or violence against others, where universities have a lot more lattitude, for obvious reasons).
(note: not a professional opinion or a specific opinion on Holmes’ case).
Were the issues with Holmes similar to the facts of the Cho situation at Virginia Tech? I don’t remember if it was discovered or revealed that Cho had ever expressed any homicidal thoughts.
I think it’s time to re-consider the obligations that mental health/medical personnel have to potentially dangerous patients. The risks have become too great.
In my opinion, no. Feeling an urge to commit a crime is neither unusual (I think we’ve all felt urges to steal before) nor a crime in itself. Additionally, why would anyone go to a psychiatrist if the result is that any normal person could end up either imprisoned in some sort of facility against their will or being harassed by law enforcement.
There’s a reason the guidelines are what they are. If they aren’t, no one will see a psychiatrist. And then you might find more mass killings, as those who feel those urges don’t see a psychiatrist and don’t get talked out of it.
It helps to have heard the actual testimony. There is a live feed that can be found at www.thedenverchannel.com. The defense begins its case next week–Thursday, I believe.
The existence of 50 Shades of Grey is enough to note that people obviously have dangerous thoughts. And every screen play in which some form of human monster does violence … like Oscar winners for No Country for Old Men or the great miniseries Fargo. How would Bret Ellis be able to write American Psycho?
Imagine the colossal law enforcement body every community would have to have to investigate every psychiatrist’s notice to police that a person “might” be considering homicide. @arabrab , would you be willing to double, triple or quadriple your taxes to pay for a large enough an investigative entity in your community?